Where can we get reliable nutrition information? Our doctors may be able to help or refer us to more expert help, but most doctors are not well trained in nutrition. The extent to which they have educated themselves varies considerably.

Nutrition is the science of food, its nutrients, and the body's response. (It is also the process of nourishment or being nourished.) If someone calls himself a "nutritionist," beware. Only about half of the states have professional standards and licensing procedures for the nutritionist designation, so look out for quacks.

Dietetics is the science or art of applying the principles of nutrition to the diet. In the yellow pages we can find Registered Dietitians, a credential awarded by the American Dietetics Association. They may have a B. S. degree in food science and some also have an M. S. degree. Some of them hew close to the A. D. A. conservative line, and some have adopted some of the newer ideas.

There are many "nutrition entrepreneurs" who are constantly flooding the bookstores with diet books for popular consumption, and some of them also sell a food product line. Their nutritional expertise varies. I cite a few of them below who have something worthwhile to say.

When you go on the Web looking for nutrition information, I suggest that you go first to the university sites. Put in your search words, make a space, and add "site:.edu". Then you might search the .org as well as the .com domains. My favorite site is the excellent Harvard nutrition site on the Web: Nutrition Source.

There is a lot of controversy in nutrition and to better understand some of it go to Clashing Views on Controversial Issues in Food and Nutrition.

Before getting into choosing eating plans or food guides I will first cover the nutrients including the macro-nutrients consisting of the "good" and "bad" carbohydrates and fats and then proteins, fiber, and water and offer some tips. I will also touch on the micro-nutrients including vitamins, minerals, and phytochemicals.

Carbohydrates

The carbohydrate foods are the backbone of diets of many cultures. They provide a clean-burning source of energy and important incidental fiber, vitamins, minerals, and phytochemicals. What exactly are carbohydrates? Here is an outline glossary of the carbohydrates:

1. Simple carbohydrates or sugars:
   • Single sugars (monosaccharides) all have the same chemical formula, C6H12O6, and are arranged in hexagons, but each one has a different structure and different degrees of sweetness. When we eat them, they are absorbed directly into the blood without digestion.
     • Glucose is the dominant simple sugar and is the dominant blood sugar. It is the product of photosynthesis in which plants using energy from the sun combine carbon dioxide from the air with the hydrogen and oxygen in water from the ground. Double sugars contain at least one molecule of glucose. Glucose molecules alone are linked together in chains to form the polysaccharides or starches and fibers. Plain corn syrup is mostly glucose and is made from corn starch.
     • Fructose or "fruit sugar," the sweetest simple sugar, is found mostly in fruits and honey. The honey bee collects sucrose in plant nectar and splits it into its component glucose and fructose, which makes it so sweet. Fructose is converted to glucose in the liver. High-fructose corn syrup contains mostly fructose.
     • Galactose is a component of "milk sugar" and is metabolized mostly in the liver.

   • Double sugars (disaccharides) are pairs of single sugars. For our bodies to use them they must be digested and split into their component single sugars. From a nutritional point of view their value is no different than pure starch, but they do cause more tooth decay.
     • Sucrose is common table sugar derived from sugar cane or sugar beets. It is formed by joining a glucose and a fructose molecule. Table sugar produces about 15 calories per tsp. Molasses is what's left from refining sugar cane into sucrose. Maple syrup from the sap of Maple trees consists mostly of sucrose. Neither of these sugary products contain significant amounts of other nutrients.
     • Lactose is "milk sugar" consisting of a combination of glucose and galactose. It accounts for about 5% of the weight of milk and an average of about 40% of milk's energy.
     • Maltose or malt sugar is a combination of two glucose molecules. It is a product of starch break-down as in plant germination and in human starch digestion.

2. Complex carbohydrates: They are called polysaccharides because they consist of strings of many glucose molecules. Three complex carbohydrates are important in nutrition:
   • Starches are the paramount energy source in most diets. Here again we need to make a subdivision:
     • Amylopectin is a form of starch consisting of a chain of glucose molecules with many branches which makes it easier to attack in digestion.
     • Amylose is a straight chain starch that digests more slowly. This is the reason that high amylose rice, such as basmati long-grain brown rice, is the best rice to eat.

   • Fiber constitutes the structural framework of plants. It consists of cellulose as in celery, hemicellulose as in bran, pectin as in apples and citrus, lignin in mostly inedible parts of plants, and gums and mucilages, which are often used as food additives for stabilizers or consistency changers. We need to distinguish between two types of fiber:
     • Soluble fiber includes some hemicelluloses (as in oat and barley bran and beans), pectins, gums. and mucilages. They dissolve in water to form a gel which slows the digestion and transit of food and lowers cholesterol.
     • Insoluble fiber includes celluloses and many hemicelluloses. Good sources are whole grain wheat products and vegetables such as cabbage and carrots. They add bulk and also slow digestion and speed up food transit in the intestines.

   • Glycogen is animal produced and is not significant in food sources, but it plays an important role in the body in temporarily storing energy. Glucose can't be stored, so the body links glucose molecules together in highly branched chains making glycogen that is stored in the liver and muscles and is easily broken up when quick energy is needed. It binds up water, so when we start a diet and the body calls upon its glycogen stores, the water is also lost, which accounts for much of the short-term weight loss that we may think is fat loss.

Sugar

Except for pleasing the tip of our tongue sugar has nothing to offer other than calories that crowd out more nutritious foods. In making food and beverage choices we need to be aware of the amount of sugar in common foods. We don't often realize just how much sugar we are consuming. For example, a 12-ounce can of a typical sugar-sweetened soft drink may contain about 8 to 10 teaspoons of sugar or about 150 empty calories. (Would you ever put 10 teaspoons of sugar in a large glass of ice tea?) Many teenagers drink two 16-ounce cans of pop per day. That's equivalent to about a 3/4 cup of sugar! To make matters worse, the sugar is usually high-fructose corn syrup, and the health effects of high levels of fructose are worrisome. See for example The Double Danger of High Fructose Corn Syrup. Yogurt is a great food, but have you ever eaten an 8 oz. cup of fruit yogurt thinking you were getting a nutritious, low calorie snack? Your yogurt contained about 7 tsp. of sugar. (Frankly, I think that is outrageous irresponsibility on the part of food companies!)

How about artificial sweeteners? Five have been approved by the FDA (saccharin, aspartame, neotame, acesulfame-K, and sucralose), and two more are under review. I use Splenda in the large box that "measures cup for cup like sugar," which is a mixture of sucralose and maltodextrin. It won't lose sweetness during long baking, which is a consideration in baking my granola. Some people may be allergic to sucralose, so one should start with a small amount.

The newest FDA approved sweetener is neotame, which is about 8,000 times as sweet as sugar. It is intended for commercial use in soft drinks, jams and jellies, baked goods, frozen desserts, puddings, etc.

There have been anecdotal reports of safety issues with all of these artificial sweeteners, but I will warily accept the FDA approval, which means that after a lot of testing nothing bad about them has been found yet. However, the long-term effect of some of the newer products is not known especially when consumed in high doses such as in diet soft drinks. (It is well to remember that sugars are not "health foods" either.) For more on the safety of these sweeteners go to Are sugar substitutes safe? Professor Marion Nestle, whose book is mentioned below, prefers sugar to artificial sweeteners, but I wonder if this is more of a philosophical position than a scientific one since she doesn't like things that are not natural.

In my tea I use liquid stevia, which is a natural herbal non-caloric sweetener that has a long record of safe use in other countries. Some people complain about a bitter after-taste, but I haven't noticed that with the Wisdom of the Ancients brand that I use in moderate amounts. It can be obtained from a health food store or online from n101.com. The FDA in its wisdom permits stevia to be sold as a food supplement but not as a sweetener and not as a food additive since they are not convinced that it is safe. For more on this interesting subject go to Stevia: Toxic or Tasty?

Some "sugar free" products contain "sugar alcohols" (polyhydric alcohols or polyols, sugar replacers) that include sorbitol, malitol, mannitol, lactitol, isomalt, and xylitol (note the "ol" ending). Polyols are used commercially for bulk and texture as well as for sweetening. They are found in jams, jellies, beverages, baked goods, chewing gum, and breath mints. They do not cause tooth decay, but they may have a laxative effect for some people. A newer polyol is Erythritol (Eridex brand made by Cerestar) that apparently is non-laxative, has only 0.2 calories/g, and is 70% as sweet as table sugar. Since the granules are somewhat slow to dissolve, it helps to grind them with a coffee grinder into a powder when it is used in baking. I sometimes use both Splenda and Eridex because I hesitate using a lot of either one alone. I obtain Eridex from Honeyville Grain. For more on sweeteners go to Sugars and Sweeteners in Food.

Here are some tips on sugar:

• Look for various forms and amounts of sugar on the ingredient list in the "nutrition facts" panel on food labels. One healthful looking fruit and nut bar includes these six forms of sugar: high maltose corn syrup (second on the ingredient list so it is second in amount), crisp rice (containing sugar), honey, sugar, high fructose corn syrup, fructose, and maltodextrin (a slightly sweet glucose polymer or short chained starch used as a fat replacer). The carbohydrate in the bar is almost half sugar.
• Desserts high in sugar are also often high in fat and cholesterol (pie, ice cream, and cake). Restaurants are notorious for offering desserts high in sugar and fat, and we don't know which fats are used. To thwart them, have a chocolate mint or some crystallized ginger in your pocket to eat after a meal instead of dessert. Crystallized ginger is sweet and may aid digestion. Another alternative is to have a decaf latte, which is milky and frothy and sweet enough to be satisfying like a dessert. When considering a piece of cake or pie or a cup of full fat ice cream, ask yourself if you really want to invest 300 to 500 of your precious calorie allotment in fat and sugar. By the time we get to dessert at dinner we have often already reached or exceeded our healthy daily calorie allotment, which may be around 2,000 calories if we are not on a reducing diet.
• Instead of eating pie prepare a dessert smoothie. Cut up an apple, pear, or mango, put them in a blender, add 1/2 cup of yogurt, and some dates. Blend until smooth and serve with a sprinkle of nutmeg on top or some good granola.
• Wean teenagers from soft drinks. Instead, offer low fat milk and, if necessary, add a little chocolate syrup. Or let them make healthful fruit smoothies with a blender using 1 cup of plain yogurt, 1/2 cup of low fat milk or orange juice or blended ice, a ripe banana, some strawberries or blueberries, apple, or peach, and if necessary a tad of sweetener such as Splenda.
• Don't let your children talk you into buying sugary kid cereals, which are only good for the health of the breakfast cereal oligopoly that shamelessly markets to kids. Parents want to make their children happy, but they also should make them healthy. So try good-tasting, healthful hot cereal with raisins and a ripe banana. A very important part of child rearing is to teach them to eat healthfully and exercise adequately. We need to be good nutrition role models.
• Since jams have a high sugar content, try reduced sugar jams such as Smucker's Low Sugar jams, which has about half of the typical amount of sugar and no artificial sweeteners.
• Learn to drink your coffee black without sugar. (Good coffee doesn't need cream and sugar, and bad coffee isn't worth it.) If sweetening is necessary, consider an artificial sweetener.

Starch

Each culture has its principal source of starch, and that may be potatoes (87% starch by dry weight of a boiled potato), bread (78% by dry wt. of white bread), rice (91% by dry wt. of polished rice), and pasta (83% by dry wt.).

Digestion of starch begins in the mouth where the enzyme amylase in saliva starts breaking down the long chain starch molecules. Dextrins are intermediate short chain molecules. (Dextrin is commercially made to use as a fat replacer.) Digestion continues in the small intestines with amylase in pancreatic juice. The resulting smaller molecules are further broken down in the intestinal walls into simple sugars, mostly glucose, which are absorbed in the blood stream. A rise in blood glucose alerts the pancreas to produce insulin, which regulates the glucose level by controlling the absorption into the cells where it is either burned or stored. To make sure that there is a steady supply of glucose, the body stores some of it in the muscles and liver in the form of glycogen and, of course, it converts excess glucose to fat.

Prior to the 1990s it was generally believed that complex carbohydrates were better for us than sugars because starchy foods were digested more slowly thus increasing blood glucose more slowly. However, research revealed that starchy foods vary substantially in the speed of digestion. So now starches are rated according to the blood glucose response. The preferred starches cause a slow blood glucose response that avoids a spike in insulin production, which will too rapidly decrease the blood level of glucose bringing on hunger pangs and an energy letdown commonly occurring in mid morning.

The blood glucose response is measured by the glycemic index (G. I.). Foods are compared to dietary glucose, which is arbitrarily rated 100. A G. I. of 55 or less is low meaning that the starch or sugar is slowly converted to blood glucose, 60 is medium, and 70 or more is high. Low is good, but we need also to look at the glycemic load (G. L.), which is the amount of glucose that is produced in a typical serving. It is calculated by multiplying the G. I. as a percentage times the grams of carbohydrate in a serving. One unit of G. L. is one gram. A G. L. of 10 or less is low, 15 is medium, and 20 or more is high. To see how this works, watermelon has a high G. I. but a low amount of carbohydrate, so the amount of glucose produced in a serving, the G. L., is relatively low. White flour has both a high G. I. and a high G. L. See Glycemic Index and Load. To get the big picture go to Glycemic Index, Glycemic Load, Satiety, and the Fullness Factor.

Since there are several factors determining the blood glucose response from foods such as the size of particles, the cooking time, presence of other nutrients such as fat and protein, and the acidity, the American Dietetics Association does't consider the Glycemic Index very helpful. See The Glycemic Index: What is it? However, some ADA members do find it useful. See below for The Good Carb Cookbook, which is subtitled "Secrets of Eating Low on the Glycemic Index," written by a Registered Dietitian. Of course, the G. I. is not the only criterion to use in choosing foods, but it is important in choosing among carbohydrates for a given meal. The ADA does advocate the use of whole grains, which do have a lower G. I. than more processed grains. However, some foods that are not heavily processed have a high G. I. such as baked potatoes.

How about low carb diets that have been popular? With the demise of Dr. Atkins interest in the very low carb diets is fading away fast. Low carb diets are often overloaded with saturated fats and protein.

Here are some tips for choosing your starches:

• Many of us were raised on white potatoes, so when we think of choosing a starch for our meal, we may only think of choosing among mashed, baked, or boiled (84% carbohydrate dry wt.) potatoes. A much better choice would be yams or sweet potatoes. Cut them cross-wise into several pieces, steam them for about 20 minutes, and then peel them. (They tend to get dried out if cooked in the microwave.) I might spread on a little whipped yogurt to offset their sweetness, or I might even use a little tub margarine.
• Another good choice is winter squash. My favorite is butternut squash.
• Also include the root vegetables including cooked carrots (35 calories per 1/2 cup compared to 81 for mashed potatoes with milk), parsnips, rutabaga, turnips, or beets. (I love to buy beets with their tops on and cook the tops for greens.)
• Other starchy choices that can also provide your protein are lentils or dry beans. Put a little lean ham in the beans (or beans and rice) or lentils, and you have both your starch and even more protein and a great taste.
• Whole grains are also a good choice. But whole means whole, not milled, such as brown rice.
• If you must have your spuds, instead of choosing baked potatoes (high G. I.) choose white-skinned boiled potatoes (medium G. I.)
• If you want rice, choose a long-grained brown rice such as basmati (low G. I.) or pearled barley (very low G. I. but no germ and less bran), which can be cooked in a rice cooker. Avoid white rice, especially instant rice (very high G. I.).
• We can also replace cereal grains with quinoa /KEEN-wah/ (available from health food stores or Bob's Red Mill online). Learn about this wonderful food that is high in protein of good quality: Quinoa from the Andes. To cook, add one cup of thoroughly rinsed quinoa with a little salt to two cups of water and bring to a boil. Turn the heat down and simmer for 20 minutes.
• Instead of white bread choose a whole grain bread made from stone-ground flour. If you grind your own, make a coarse flour. Whole wheat bread is not a whole grain food, but it is better than white bread. Many consider bread a necessary part of their meal in addition to our other starch. That may be OK if you are a ditch digger, but it isn't good for the rest of us. Also be careful about what fats you spread on the bread and how much. Consider having sandwiches closed or open-faced even for dinner instead of having another starch. For example, have pot roast beef and its gravy on whole wheat toast plus a vegetable like broccoli and a small mixed green salad.
• Cooking a cereal grain makes the starch grains release the amylose and amylopectin, which absorb water and thicken. Remember that the more we cook the cereal and the creamier it gets, the higher the G. I. So, the cereal should be a little chewy. We can add some raisins to the cereal for sweetness and flavor and skip the sugar.
• Buy or make whole wheat pasta and cook it al dente. For a non-meat spaghetti sauce add cooked lentils to the tomato sauce. (I make lentil soup and add spaghetti sauce to the leftover lentils.)
• As a general rule avoid white starchy foods. When you eat out, send the bread basket back if it is French bread, which has a very high glycemic index. To spread on butter reduces the G. I. but contributes saturated fat. If your selected dish comes with potatoes (or other white starch), make a request to hold the starch and double the vegetables. That seems to be a fairly common request in good restaurants, but it might surprise a waitress in Joe's Diner.

Fiber

Food refining often removes fiber as in grain milling, rice polishing, and orange juicing. This not only removes valuable fiber, but also removes valuable vitamins and minerals.

We need adequate amounts of both insoluble fiber as in wheat bran and carrots and soluble fiber as in oat bran and apples. To learn more about the many virtues of fiber go to Fiber.

One of the major dietary problems that we seniors have is getting enough fiber and water to keep things moving. Even a good diet emphasizing whole foods may not provide enough fiber for us. We may benefit from taking psyllium, a soluble fiber. Metamucil may be the best known brand, but it is not the most economical source. I buy psyllium husks from a health foods store. They are free from questionable additives.

Pysllium may also benefit younger people who are overweight. Taking two teaspoons of psyllium with 8 ounces of water 30 minutes before a meal has been suggested as a weight loss aid, but one should check that out with a health care professional. (See for example Herbs for Obesity)

With a high fiber diet be especially careful to drink adequate fluid.

Insulin and Glucagon

Before we leave the subject of carbohydrates, we need to consider the yin and yang of our glucose management system. Our system maintains a fairly constant level of glucose of from 80 to 120 mg per 100 dl of blood. When we eat, the glucose level goes up triggering the beta cells in the pancreas to produce the "feasting hormone," insulin, which stimulates the muscle and liver cells to store glycogen and to make protein from amino acids. It also stimulates the fat cells to store fats, and this is a problem if we are trying to lose weight.

When we go without food for a while, the "fasting hormone," glucagon, is produced by the alpha cells of the pancreas. It stimulates the muscle and liver cells to convert the stored glycogen back into glucose to supply the brain and other cells. When our glucose level is too low, we have hypoglycemia, which can make us shaky and light-headed.

Type 1 diabetes or juvenile diabetes occurs when insulin is not supplied. In late middle age insulin resistance may occur in the cells, blood sugar rises, more insulin is produced, and the person starts down the path toward Type 2 or adult onset diabetes as the glucose level rises. To learn more about this vitally important subject, go to Insulin Resistance and Pre-diabetes. Advancing age and weight are the main risk factors, but to learn more about diabetes and other risk factors go to Am I at Risk for Type 2 Diabetes?

Back to the Beginning

Fats

The subject of how much fat we should consume is controversial, but the Harvard nutritionists say that the problem is not so much the amount of fat that we eat but rather the kind of fat. So let's start off with a brief outline glossary on fats and see what is good and what is bad. Here are the three kinds of lipids or fatty substances:

1. Triglycerides are the common fats and oils that we know so well. The name is derived from the fact that three fatty acids (the basic building blocks of fats) are attached to a glycerol forming a large triglyceride molecule. Triglycerides contain a mixture of fatty acids that determine whether the fat is hard or soft. Your doctor probably mentioned triglycerides when he went over your serum lipid profile with you. (Amounts over 200 mg/dl are a heart disease risk.) Since triglycerides don't mix with water in the blood, they are carried around by lipoproteins. Here are the three fatty acids found in triglycerides:
   • Saturated fatty acids: These are fatty acids saturated with hydrogen. Saturated fatty acids produce triglycerides that are firm at room temperature. They predominate in animal products and in tropical oils---coconut and palm seed oil. Beef tallow is 50% saturated while lard is 40% saturated. Saturated fats increase the level of both LDL and HDL cholesterol, so they are unhealthy fats.
   • Monounsaturated fatty acids: The fatty acid molecules have an empty space where one hydrogen atom could be added. They produce triglycerides that are liquid at room temperature but may not be liquid in the refrigerator as in the case of olive oil, which is about 75% monounsaturated. They lower your LDL cholesterol and increase your HDL cholesterol, which is good.
   • Polyunsaturated fatty acids: These fatty acid molecules have spaces for two or more hydrogen atoms. They are liquid or soft at room temperature. Sunflower oil is 66% polyunsaturated. They also lower LDL and increase your healthy HDL cholesterol. They include two families of fatty acids each of which contains an essential fatty acid that is, well, essential in a healthy diet. We need to watch the balance between these two families of fats (A good ratio is 3 omega-6 to 1 omega-3, and in the typical American diet it is about 20 or more to 1):

     • Omega-6 (LA family): Linoleic fatty acid is the essential one in this family. It's commonly found in sunflower, safflower, and corn oils. They do promote inflammation whereas omega-3 is anti-inflammatory, so they need to be consumed together in the right proportions.
     • Omega-3 fatty acids (ALA family): The essential one in this family is alpha-linolenic acid. See Omega-3 Fatty Acids and Essential Fatty Acids in Vegetarian Nutrition. Oily wild fish and flax seed are excellent sources of omega-3. (The use of fish oil supplements is controversial.)

2. Sterol group of which cholesterol is the one we know best: Cholesterol is produced and stored in the liver.

3. Phospholipids of which lecithin is the best known: Lecithin is made by the liver and is found in some foods. It is an important part of cell membranes. Lecithin is an emulsifier, which is why egg yolks containing lecithin are used in making mayonnaise.

Hydrogenated fats are a favorite of food processors. Unsaturated fats are subject to oxidation causing rancidity, and they are liquid at room temperature. So, food processors like to at least partially hydrogenate or saturate the oil with hydrogen. Saturation hardens the oil as is the case with stick margarine. Hydrogenated oils also have a higher smoking point, so they are desired for deep fat frying. There are two health problems: 1) Good unsaturated fatty acids become bad saturated fats. 2) Some of the unsaturated fatty acids are changed in shape to become trans fats. They increase the bad LDL cholesterol and lower the good HDL, so not surprisingly an association has been found between trans fats and heart disease. For more on trans fats go to Trans Fats.

Wouldn't it be nice if we had a product with the mouth feel of fats but not the calories? We do have it with fat substitutes, but they pose problems. (There's no free lunch in nutrition.) One concern with these fat replacers is that since they are not digested they pick up fat soluble vitamins (A, D, E, & K) in the same way that mineral oil does and carry them out in the stool. See Dietary Fat Replacers.

Most of the fat digestion takes place in the small intestines. The fat must first be emulsified by bile stored in the gallbladder and made by the liver so that lipase from the pancreas can strip fatty acids from the triglycerides. Some of the bile is caught by dietary fiber (mostly soluble fiber such as oat bran) in the large intestines and eliminated. Since cholesterol is used to make bile, this results in lowering blood cholesterol. The triglycerides are either absorbed directly into the blood stream or are reassembled into new triglycerides, wrapped with a lipoprotein to make them mix with the blood, and sent on their way in the lymph system.

Lipoproteins and Cholesterol

Lipoproteins are little packages with a "wrapper" consisting of phospholipid and protein containing lipids (cholesterol and triglycerides). Since triglycerides and cholesterol are not soluble in the water in the blood, they must be ferried around in these lipoprotein packages. The density of lipoproteins is determined by the amount of lipids they transport; the more lipids, the lower the density. There are four main types that carry cholesterol, and they are often simply called "cholesterol":

1. High Density Lipoproteins (HDL, think HealthyDL): They carry excess cholesterol and phospholipids to the liver for disposal, which is why the are "good.".
2. Low Density Lipoproteins (LDL, think LousyDL): They carry triglycerides and cholesterol from the liver to be deposited in different parts of the body including artery walls, which is why they are considered "bad."
3. Very Low Density lipoproteins (VLDL).
4. Chylomicrons, which are the largest and least dense and are assembled in the intestinal cells. They transport dietary lipids to the rest of the body. You may hear a lot more about them in the future, so remember that you read it here first. See Chylomicrons.

For more information go to What are cholesterol, other lipids, and lipoproteins?

Fat Formation and Burning

The body makes fat from dietary fat and also from glucose, which requires more energy. When we eat more carbohydrates than we burn and have a full store of glycogen, our cells turn glucose into fat by breaking it into pieces and using the pieces to make fatty acids. Low fat diets high in carbohydrates with a high ratio of sugar to starch increase saturated fatty acid synthesis that increases the circulating triglyceride level, which is a heart disease risk. For more on this subject go to Effect of High Carbohydrate Feeding on Tryglyceride. The fat is stored in adipose tissue in specialized fat cells that can expand like a balloon. Fat stored under the skin is called subcutaneous fat, which makes pear shaped women in their reproductive years, or deep within the abdomen as visceral fat, which makes apple shaped men and older women. Visceral fat carries a higher risk of heart disease.

Fat supplies a major part of our energy needs. When the body needs energy, it uses up its stored glycogen rather quickly and then turns to its fat supply. Upon demand fatty acids are released into the blood where they are broken into fragments which are combined with glucose fragments to produce energy, carbon-dioxide, and water in the clean-burning process. However, if glucose is not available, ketosis occurs and ketones are produced instead of carbon-dioxide and water. The body can burn ketones, but they upset the body's acid balance that can cause unpleasant side effects such as bad breath and headaches. This is one problem with the Atkins diet.

My favorite authority on fats in the diet is Dr. Willett and the Harvard School of Public Health. See Fats and Cholesterol.

Here are some tips for food choices with respect to fats:

• Read the labels on fatty foods and be on the lookout for trans fats and avoid them. (All nutrition labels must now show the amount of trans fat.) In the ingredient list look for and minimize "partially hydrogenated vegetable oils" and palm and coconut oils since they are saturated oils.
• If you buy margarine, buy the tubs. In a tablespoon serving size (14g) one popular tub contains 5g of total fat of which 1g is saturated, 2.5g is polyunsaturated, and 1.5g is monounsaturated. There is 0% trans fat (less than 0.5g), which is good. However, the ingredients list includes partially hydrogenated soy oil as the third ingredient, which means third in amount.
• Instead of using butter or margarine try dipping your bread in olive oil like the Mediteranians do. Better yet put a little balsamic vinegar in the oil. This adds to the flavor and the acid reduces the G. I. of the bread. I spread olive oil with a spoon on my bread at home.
• Buy omega-3 rich eggs, which are also lower in saturated fats.
• Use Canadian bacon (if you can find a decent brand) or turkey bacon such as the Louis Rich brand instead of pork bacon.
• Deep fried food in a restaurant or fast food place is hazardous to your health! There are four problems: (1) Their fats are usually high in saturated fats and trans fats. (2) They nay use the fat too long before changing it. (3) The fats add a lot of calories to the food. Restaurants cooks often put too much food in the fat, which lowers the temperature causing the food to soak up more fat. (4) If the other three reasons for not eating restaurant French fries are not enough, this one should grab your attention: They may contain a carcinogen called acrylamide, which is produced when starches are cooked at high temperatures. For more information go to Acrylamide.
• Cut your use of saturated fats but be sure that you are getting a good supply of omega-3 fatty acids. Have an oily fish not only on Friday but have three or more servings of wild salmon, mackerel, or sardines per week. This is a good way of getting protein without a load of saturated fat. Also make flax seed meal in your coffee grinder and use it often in your hot cereal, soups, stews, casseroles, etc. Grind about 1-1/2 Tbsp. of flax per person. Since it is high is fiber, increase your fluids. Walnuts are also rich in omega-3, so use them in your cereal, salads, hot breads, pancakes, waffles, etc. Since they have abundant calories, cut calories elsewhere. Keep them in the refrigerator.
• If you want a low cal replacement for fat in a baking recipe, try unsweetened applesauce or better yet a 50/50 mixture of apple sauce and buttermilk.
• Use olive or canola oil and vinegar dressings on salads. Both oil and vinegar slow the digestion of carbohydrates. I often use both white and balsamic vinegar.
• The fat soluble vitamins, A and E, and certain valuable phytochemicals such as lutein in spinach, lycopene in tomatoes, and zeaxanthin in corn and romaine lettuce require the presence of fat for digestive absorption. Therefore, one should dress salads with a dressing containing oil and dress cooked vegetables with a little olive or canola oil if there isn't fat present in other foods in the meal.
• When you need to use mayonnaise, use a light or low fat product and mix it with plain yogurt.
• Eat adequate soluble fiber from such sources as oats, barley, and apples, which reduces your LDL cholesterol.
• Instead of baking a two crust apple pie, stuff some whole cored apples with raisins, walnuts, and a little brown sugar and bake. Regular pie crusts with white flour and shortening are junk food.
• One tablespoon of ground flax mixed with 3 tablespoons of liquid replaces one egg in baking. This works especially well in muffins, pancakes, cookies and cakes.

Protein

Proteins consist of amino acids joined end to end. The amino acids consist of carbon, hydrogen, and oxygen just as carbohydrates do, but they also always contain nitrogen and may also contain other elements. Amino acids are used as building blocks for enzymes, hormones, hemoglobin, and many other compounds as well as for muscle if we are exercising. Although protein is vitally important, more is not always better. Too much protein overworks the kidneys.

There are some 20 amino acids and all but 8, which are called the essential amino acids, can be synthesized in the adult body. A "complete protein" contains all of the essential amino acids, as in all animal products such as meat, milk, and eggs. Our bodies utilize amino acids in a set proportion; therefore, if the protein is short on one essential amino acid, we can utilize less of the other amino acids for protein. So complementation increases the total protein utilization.

Cereal grains contain a modest amount of protein, but it is not a complete protein since it is especially short on the essential amino acids, lysine and isoleucine. They do have a good supply of tryptophan and sulfur-containing amino acids. Beans, on the other hand, have just the opposite amino acid profile, so you can see why grain and beans are such a good marriage. Each complements the other.

Milk has a complete protein but is especially rich in lysine, so milk supplements and complements the protein in oatmeal. Lappe in her Diet for a Small Planet said that the complementary protein must be eaten simultaneously to balance each other, but it is now generally thought they can be consumed a few hours apart. However, the "bookkeeping" is easier if we balance the proteins in each meal. For more on proteins go to Complementary Protein and Diet. Each culture has serendipitously found complementary foods that provide adequate amounts of all 8 amino acids in such combinations as beans and rice in Mexico and rice and soy products in Japan.

Digestion breaks the proteins into their component amino acids. It starts in the stomach where strong hydrochloric acid modifies the protein so that the pepsin enzyme can ultimately split the polypeptides into amino acids. In the small intestine the acid is neutralized by alkaline pancreatic juice. The intestine's cells either make needed new proteins or convert the protein into glucose for energy. Amino acids not used go into the blood stream and are carried to the liver where they may be used or put back in the blood for the use by other cells to make protein or for other uses.

According to the Harvard experts, we need a minimum of 1 gram of protein per 1 kilo (0.454 gram per pound) of body weight per day. If your healthy body weight is 150 lb or 68 kilo, you need a minimum of 68 grams of protein per day. Four ounces of lean beef contains 35g, one large egg contains 6.5g. One serving of oatmeal contains 3.5g.

When we have a surplus of amino acids, they are disassembled because they can't be stored; we use'm or lose'm. The amino group in the amino acid is excreted as urea, and the remaining "carbon skeleton" is converted to glucose and burned for energy or stored as fat. If the cells are hungry and have no glucose or fat available, they will disassemble the protein in muscle tissue to provide needed glucose for energy especially to feed the brain.

Here are some tips on proteins:

• Remember that beans are an excellent very low fat source of protein, and when eaten with a whole cereal grain, we get a good complete protein. There is a big variety of beans, and they can be prepared in many ways. Have you tried black beans lately? Try seasoning colored beans with balsamic vinegar. Remember that we can live very well without meat and potatoes!
• Try to avoid hamburger and any feedlot beef because it is fatter, and the animals are more likely to have been given antibiotics, growth hormones, and animal products in their feed.
• How would you like a grilled burger without the saturated fat? Try grilling Portobello mushrooms. To find out how, go to Grilled Portobello Burgers. This is an especially great tip if you have kids who love hamburgers or if you are a vegan or vegetarian. For two people I like to brush two small portobello caps (3 in. in diameter) with a mixture of olive oil and balsamic vinegar, let stand, and fry along with slices of half of an onion for about 5 minutes on each side and serve with lentil, pea, or bean soup to increase the protein. Skip the fries! Portobello burgers are appearing on lots of restaurant menus. If you want a big burger, use six-inch caps.
• Eat lots of oily wild fish such as salmon, sardines, and mackerel. Canned salmon is good because it is normally wild salmon.
• Balance and supplement the proteins in hot whole grain cereal by adding milk. I also add some diced firm tofu.
• Have adequate protein for breakfast as well as low G. I. starch to help avoid the midmorning letdown. Avoid white flour hot cakes, waffles, coffee cakes, toast, and muffins, and avoid all doughnuts.
• Eggs are a good source of high quality protein. My LDL cholesterol is a little high, so I go easy on eggs and use "omega-3 eggs." I also often used powdered egg whites, which I obtain from Honeyville Grain. If I make an omelette, I may use two egg whites to one yolk.
• Yogurt is a good source of protein and calcium but avoid sugar-laden commercial fruit yogurts. Yogurt is very easy to make, so I make about 1/2 gallon per week. For a recipe go to Making Yogurt at Home. I like to add yogurt to cream sauces, to mix it half-and-half with mayonnaise when making cole slaw, to mix it with fruit and serve with granola, and to use it in fruit smoothies. Yochee makes a good spread especially if you add a little dill. To make yochee, put regular yogurt in a coffee filter and let it drain into a cup in the refrigerator, or use a yochee maker Cuisipro Donvier Yogurt Cheese Maker.
• Cultured buttermilk is also a good source of protein and calcium. (It is the adult milk drink. Babies have the lactase enzyme that breaks down lactose in regular milk, but most adults except for about 70% of those from European stock lose this capability and have problems with lactose.) You may have to acquire a taste for buttermilk, but you probably had to acquire a taste for Chardonay. The acidity makes it a refreshing drink and may slow the digestion of carbohydrates. Buttermilk containing live cultures may also improve your intestinal bacteria population.
• Soups are a great way to reduce fats. One of my favorites is turkey soup made with turkey legs (remove skins before cooking), onions, carrots, celery, and zucchini. Five minute before it is done, I add frozen peas to give it a nice touch. If you make chicken soup, remove the skin and skim off the fat. (I use a fat separator.) A bowl of pea soup and whole wheat muffins made with a good oil followed by fruit makes a great lunch with a complete protein.

Back to the Beginning

Water

Not the least of the essential nutrients is water. Dr. Willett says that we need 64 ounces of fluid from food or water per day if we are on a 2,000 calorie diet. If we do activities that raise a sweat, we need more. Caffeine and alcoholic drinks don't count as much as water because they are diuretics. Unfortunately, it is getting more difficult to be assured of good quality water.

Bottled water is not necessarily good quality water. The FDA regulates water sold in interstate commerce, but their standards are low. The National Resources Defense Council found that about 25% of bottled water is simply tap water with or without further treatment. Come to think of it, in view of all of the air pollution I think I will start selling bottled air.

Tips for drinking more fluid:

• Have a full glass of warm water when you first arise in the morning.
• Have a nice cup of green tea mid-morning and mid-afternoon. If you buy green tea, buy tea decaffeinated with water or carbon-dioxide rather than by chemicals.
• Have a glass of water 30 minutes before lunch and dinner.
• Use a twist of lemon or lime in your glass of water to make it more appealing.
• If our urine imparts much yellow to the water in the toilet bowl and if we are not taking large doses of riboflavin and other substances that make the yellow color, we are not drinking enough water.

Micro-nutrients

Finally, we come to the vitamins and minerals. When I was in grade school, we were taught this mnemonic: Colored (A), vital (organs, B1 or thiamine), coverings (B2 or riboflavin), fresh (fruit and vegetables for C), sunshine (D), variety equals vitamins. Knowledge of vitamins has come a long way since then, but the "variety equals vitamins" is still good advice.

The main question is whether or not we need vitamin supplementation. How many times have you heard this mantra (often from doctors): "If you eat a well-balanced diet, you do not need vitamin supplements." That's an obvious truism, but who eats a really well-balanced diet and how many of us would know if we did? The Harvard School of Public Health recommends a standard daily multivitamin "to fill the holes." See their page on Vitamins. Also see Calcium and Milk for a few surprises, especially that diets high in calcium has been implicated in prostate cancer.

Some people need supplementation more than others. For example, we seniors who have a low food intake and lower absorption may need more vitamins and minerals across the board. Strict vegetarians need supplemental vitamin B12. Menstruating women need more iron. People who don't drink milk or get out in the sun need more vitamin D.

We often read about the importance of antioxidants that protects cells and compounds like DNA from free radicals produced by oxidation. The free radicals are molecules missing an electron, and they go after DNA and other molecules to get the electrons. Antioxidants generously give up electrons to free radicals so that they don't get them from DNA and other molecules. Antioxidants include vitamins C and E, carotenoids, selenium, manganese, and probably many unknown substances. Dr. Willett advises that instead of taking high dose antioxidant pills we should eat lots of fruits and vegetables in order to get the full array of antioxidants.

In addition to vitamins and minerals phytochemicals (plant chemicals) have importance in the biological activities of the body as in protecting against diseases. For example, one important phytochemical is lycopene, a powerful antioxidant in cooked tomatoes, is thought to protect against certain cancers. Phytochemicals are another important reason for eating our fruits and veggies.

When thinking of vegetables think of the crucifers (cabbage, brussels sprouts, cauliflower, broccoli, kale, and collards), cooked greens (spinach, chard, and beet tops), legumes (green peas and beans), summer squash, red and green peppers, and mixed green salads and choose regularly from all of these groups. Think of root vegetables like carrots (not potatoes) as more desirable starches.

Balancing the Calorie Budget

All of the macro-nutrients produce calories (yes, including protein), which are a measure of the amount of energy provided by the "fuel." Fats are loaded with calories: 9 calories per gram (120 calories per Tbsp.) compared to 4 for carbohydrates, 4 for proteins, and 7 for alcohol. Our daily calorie requirement depends upon our Basic Metabolism Rate (BMR) and our physical activity. The BMR is approximately the amount of calories we burn while resting. It depends upon our genes, gender, age, size, body type, and muscle to fat ratio. ("Calories" is usually shorthand for kilocalories.)

An outstanding food analysis source is Food Category Explorer. Suppose that you want an analysis of long grain brown rice. At the top click "Cereal Grains & Pasta," type in "brown rice," and enter. On the next screen click "Rice, brown, long-grain, raw." Under "Food Energy" you can read the calories from carbs, fat, and protein and the total calories per serving. Cursor down to find a detailed analysis. Another food analysis source is USDA food values. The textbook cited below and others like it contain food analysis tables.

So, how many calories do we need per day to maintain a healthy weight? If our activity is light, we need roughly 15 calories multiplied by our healthy weight (1,800 for a 120 lb. woman and 2,250 for a man whose healthy weight is 150. For a more accurate calculation, go to Calorie Calculator. The trick in making food choices is to get the most nutrition within our daily calorie allowance.

Physical Activity

Exercise burns off calories, but it also increases the desirable HDL in the blood, improves the heart's pumping efficiency improving circulation, reduces the risk of cardiovascular disease, and strengthens the bones. Those benefits should get us off of the couch, but there are many more. For more excellent information from Harvard go to Exercise. Notice that there are three important types of exercise: 1) cardiovascular exercise from such things as brisk walking for 30 minutes, 2) stretching exercise (when we are warmed up) to make us more limber, and 3) resistance exercise or weight training to build muscle mass, which increases the basal metabolism rate burning more calories while we are resting.

Elderly people are most likely to get inadequate exercise. Our BMR decreases as well as our physical activity when we age. Since our physical activity is less, our muscle mass decreases which also reduces the BMR. This explains why most people put on weight as they age. The more weight they put on the less they want to exercise.

To learn some good exercises go to Exercises for the Elderly; I especially like the "wall pushups." Walking is good, but we need some upper body exercise to build muscle. I walk with a walking stick changing arms periodically. That gives my arms some exercise, but they need more.

Talk to your doctor before starting an exercise program.

"Nutrition Facts" on Food Labels

One of the greatest advances in consumer protection is the "Nutrition Facts" labels on foods showing the basic per-serving nutritional information as required by the Nutrition Labeling and Education Act of 1990, which was amended in 2003 to be effective January 1, 2006, to require showing trans fats. The label now shows the serving size, the servings per container, calories per serving, calories from fat, and for the following it shows the amount in grams or milligrams and the "% Daily Value": total fat, saturated fat, trans fat, cholesterol, sodium, total carbohydrates, dietary fiber, sugar, and protein. It also shows the % daily value for vitamins A and C and for iron and calcium. The "Daily Value" standard is the daily need for an average person eating 2,000 and 2,500 calories.

(There is another set of nutrient standards called the Dietary Reference Intakes (DRI), which includes the population-wide Estimated Average Requirements (EAR), Recommended Dietary Allowances (RDA) for people with the highest needs, Adequate Intake (AI) for individuals when the RDA has not been established, and Tolerable Upper Intake Level (UL). The Daily Value standard on food labels is presently based on the 1968 RDA but includes requirements for some nutrients not covered by the RDA.)

The panel doesn't show the nutrient percentages by weight. However, this is easy to calculate since it shows the serving size in grams and the nutrient per serving in grams.

Another important section of the Nutrition Facts panel is the list of ingredients in the order of the amount by weight. Look for partially hydrogenated soybean oil, which is not good. There may be several types of sugars, but the sugar amount is for the total. There also may be one or more of about 3,000 food additives. They are added to improve flavor, color, texture, stability, nutrition, and resistance to spoilage. They are all approved by the FDA, but the more polysyllabic chemicals a food includes the less I am inclined to buy it. To get the information on a food additive and its purpose, go to List of Food Additives. Since they are not listed alphabetically, use their "search" slot to find all about a particular ingredient. My favorite to exercise my tongue is polyvinyl polypyrrolidone (a color stabilizer).

For more information on food labels go to How to Understand and Use the Nutrition Facts Label.

Back to the Beginning

Food Guides

I will describe three types of food guides from the simple to the more complex.

Food Pyramids

The most publicized food guide for the general public is the graphic from our US Department of Agriculture called MyPyramid. (This streamlined 2005 model is similar to the old "Food Guide Pyramid" except that it is turned on its side. A little figure running up the side of the pyramid stresses the importance of physical activity.) By plugging in your age, sex, and activity level, you can get a rough personalized food recommendation.

Isn't it interesting that MyPyramid is a product of the USDA, a department representing agriculture, rather than by Health and Human Services? I have much more confidence in the Harvard School of Public Health's "Healthy Eating Pyramid." To see it, go to Food Pyramids. The Harvard site has many good pages that you can access by clicking on subjects on the left-hand side. Read what it says about the USDA's pyramid and Dietary Guidelines for Americans 2005.

There are many other pyramids. My elderly peers may want to go to Reinventing the Food Pyramid for Older Adults.

If you are not a member of our American "meat, potatoes, and veggie culture," go to Alternative Pyramids.

Food Guides/Eating Plans

The best known food guide is the USDA Food Guide. Go to Dietary Guidelines for Americans: Notice in Chapter 2 they compare the USDA Food Guide with the DASH (Dietary Approaches to Stop Hypertension) Eating Plan. The USDA Food Guide is better than their food pyramid, but it could be better.

My favorite accessible and authoritative guide book is Eat, Drink, and Be Healthy: The Harvard Medical School Guide to Healthy Eating (2005) by Walter C. Willett, head of the Department of Nutrition. His recommendations are research-based, and he cites a lot of the research studies. He takes a stand on many important nutrition issues where nutrition textbooks may simply present the different points of view. He advocates eating fewer bad fats and more good fats, fewer refined grains and more whole grain and low glycemic carbs, fewer potatoes and more vegetables, and less red meat and more beans, nuts, fish, poultry, and eggs. The book includes a few menus and many recipes. To see a good portion of the Harvard wisdom, go to Nutrition Source.

An excellent book on supermarket foods is What to Eat (2006) by Marion Nestle, a nutrition professor at New York University. She is an expert on the politics of food, and her book is heavily laced with the subject. It is infuriating to find out how much big business adversely influences food selection and regulation. She exposes marketing ploys to get us to eat more overly processed food laced with polysyllabic food additives and various sugars and fats. It is interesting to consider to what extent the food industry is responsible for the current obesity epidemic. She often relates her own experiences that give the book a nice personal touch. She gives a lot of conservative guidance on food selection, but the ten most important words that she wants us to remember is "eat less [especially junk food], move more, eat lots of fruits and vegetables." I think her book is an interesting and enlightening long read (about 600 pages). To read an interesting story about her, go to Down to a Science.

Diet Books

There are many diet books or food guides written by "nutrition entrepreneurs." I say "entrepreneurs" because some have made good money on their books and, in some cases, on their food product lines and also because most are not trained as nutrition experts. However, some of them have become well-informed. "Diets" include short-term weight loss diets (many of which are fad diets), long-term "lifestyle" diets, and most have a combination of both in phases. Here are several popular diets and guides worthy of consideration:

• The G. I. Diet The Easy, Healthy way to Permanent Weight Loss (2002) by Rick Gallop: Although Gallop doesn't have formal scientific credentials, he has clearly done his homework as well as having had personal experience. He came up with a food guide that is very easy to follow and is based on principles similar to those advocated by Dr. Willett. The food choices are listed in green, yellow, and red panels according to their G. I. and fat profile. Serving sizes are described in terms of how much of the plate they cover. (Cover half of your plate with vegetables, 1/4 with lean meat, and 1/4 with starches. An excellent example would be 1/4 with lean meat, 1/4 with carrots for your starch, 1/4 with broccoli, and 1/4 with peas.) It also includes recipes. During Phase 1, the weight loss phase, his goal is to lose 1 pound per week by eating only "green-light" foods, which includes a generous amount of low G. I. carbs, with controlled portions. Phase 2 is the weight maintenance phase that permits one to eat some "yellow-light" foods and larger portions. His second book, which is more useful for most people, gives a summary of the G. I. diet concept and has many more recipes and tips: Living the G. I. Diet (2004).

• The South Beach Diet: The Delicious, Doctor-Designed, Foolproof Plan for Fast and Healthy Weight Loss (2005) by Arthur Agatston: As a practicing cardiologist, he is especially interested in how diet relates to blood chemistry, obesity, and cardiovascular health. The first of the three phases in his plan lasts two weeks and cuts out starchy or sweet foods including potatoes, bread, pasta, rice, and even fruit. His theory is that this is needed to fix insulin resistance before going on with the more liberal phases. (This very low carb phase is the controversial part of the diet and should be discussed with ones doctor. Much of the weight loss in this phase will be water.) Phase 2 is less restricted and continues until one reaches ones weight goal. Phase 3 is a long-term diet with the expectation of weight stability. He emphasizes eliminating bad fats and high glycemic carbs. Phase 3 appears to be a well-balanced and healthful lifestyle diet. He includes a lot of menus and recipes, and in a separate small book he tells us what foods to enjoy and to avoid: The South Beach Diet, Good Fats Good Carbs Guide.

• The Good Carb Cookbook (2001) by Sandra Woodruff: This is another book advocating the choice of foods with a low glycemic index and good fats. She includes more than 200 recipes and an extensive table of the G. I. of foods. It is similar to Living the G. I. Diet, but it isn't as easy to follow. It does have more to say about nutrition and includes several menus for breakfast, lunch, and dinner and gives the page for the recipe for many of the items. Example: Baked Chicken Dijon (page 235), baked sweet potato, Fresh Roasted Asparagus (page 195), and Spinach and Pear Salad ((page 165).

• The New Glucose Revolution, (2003) by Jennie Brand-Miller et al.: This is the latest and most authoritative guide to the Glycemic Index, which may be one of the most important developments in nutrition in the last two decades. It clearly explains the concept and includes the most authoritative Glycemic Index table. The recommendations are sometimes a little lax or inconsistent with the low G. I. stance, but the book is a useful reference book. A related book is The New Glucose Revolution Pocket Guide to Losing Weight. I prefer The G. I. Diet by Gallop.

• The New Sugar Busters! (2003) by Steward, Andrews, Bethea, and Balart: They recommend cutting out the sugar but also cutting out high G. I. starches. Their diet is about 40% (or more on a weight maintenance diet) carbohydrates, 30% protein, and 30% fats. They place great emphasis on modulating insulin levels for weight control. Whether all of their theories are correct or not, it appears that they advocate a healthy lifestyle diet. They list and give recipes for "super foods," and they give many recipes from well known restaurants.

• Eating Well for Optimum Health by Andrew Weil, M.D. (Get a like-new used hard cover book for about $0.21 plus shipping from an amazon.com affiliated used book dealer.) I am not a big Weil fan, but I think he did a good job on this book. I like the depth of his treatment of the basics of nutrition emphasizing eating the good fats and the low-glycemic carbohydrates. He gives some suggestions for breakfast, lunch, dinner, and snacks and includes a lot of recipes and dietary recommendations for common health problems, but he doesn't give a well-defined eating plan.

• Nutrition for Life (2005) by Lisa Hark and Darwin Deen. This is a very attractive, colorfully illustrated, very accessible book that espouses the "traditional dietetics." Little consideration is given to the glycemic index. It's brief, 336 pages including a food analysis table covering 500 foods. It includes a review of many widely used diet programs, a section on food as medicine, and a food analysis section that includes the saturated fat content. It gives rather general dietary guidelines that are similar to the USDA Food Guidelines but less detailed.

• Mastering the Zone: The Next Step in Achieving Superhealth and Permanent Fat Loss (1997) by Barry Sears, Ph.D.: Having been trained in biochemistry, he defines the "zone" as "the balance of hormonal responses" after eating. It is the zone or state in which insulin level is not too high or low. His theory is that we need to have a 40-30-30 balance among low glycemic carbohydrates, protein, and good fats. This is fairly low carbohydrate and high protein intake by current mainline nutritional standards. He measures nutrient amounts in units he calls "blocks," which are similar to units that dietitians call "exchanges" (see below). To plan a menu, you start with your "protein prescription," which is based on your sex and level of activity, rather than starting with a calorie allotment. A block of protein is 7 grams, and if you choose lean beef for your protein, this is one ounce. You may be allowed, say, 12 blocks of protein divided into three meals. To balance this, according to his theory, you would be allowed 12 blocks of carbohydrate of 9 grams each as in 1/3 cup of cooked potato. You count blocks instead of calories, but it is a little too complicated for my taste. He includes a lot of menus and recipes. After losing weight you stay on the same diet.

• Protein Power Lifeplan (2000) (less than $1.00 used hardcover) by Michael R. Eades, M.D., and Mary Dan Eades, M.D.: Their "lifeplan" has three levels and each level has three phases. The plans are all relatively high in protein and go from low to very low carbohydrate. They don't consider the G. I. in making carbohydrate choices. They make an impressive argument for their position, but until they can produce more evidence I wouldn't want to go any further than their least restrictive plan.

All of these food plans recommend that we replace bad fats (saturated and trans fats) with good fats, and some of the plans recommend that we eat low glycemic carbohydrates or at least to replace highly processed grains with whole grain and eat lots of fruit and vegetables. The diets differ on the best combination of carbohydrates, proteins, and fats. To better interpret the recommendations, we should consider what the World Health Organization recommends: carbohydrates 55-75% of total energy, protein 10-15%, and fat 15-30%. These are wide ranges, and the WHO is not infallible. However, the ranges indicate that a 40-30-30 balance as in The New Sugar Busters! and in Mastering the Zone is quite low in carbohydrates and high in protein by WHO standards. The Protein Power Lifeplan is even more extreme. I didn't mention the most extreme diets: the Atkins diet with very low carbohydrate and high protein and fat or the Pritikin and Ornish diets with high carbohydrate and low protein and fat.

Determining the most healthful diet for an individual or for a group is an extremely difficult scientific problem and one that is always clouded with uncertainty and controversy. Science will never find the whole truth; it will only approach it by one consensus approximation after another. The 2005 consensus approximation will look quite outmoded in 2020. However, we shouldn't cynically ignore all recommendations; we should look for the authorities with the best credentials and follow their recommendations knowing that they are subject to change. Some of the nutrition entrepreneurs have some good ideas, but many of their conclusions are hypotheses rather than well-researched findings. The expert nutritionist in whom I presently have the most confidence is the Harvard scientist, Dr. Willett. My choice among the popular diet plans is the G. I. Diet plan of Rick Gallop, which I think is quite consistent with Dr. Willett's conclusions.

For a University of Michigan comparison of several "fad diets" go to Fad Diets: Low Carbohydrate Diet Summaries.

Introductory Nutrition Books

Introductory nutrition books are those used by colleges for nutrition majors and non-majors, but they are usually accessible, well-illustrated books suitable for anyone interested in nutrition. Here is the leading introductory nutrition textbook in the universities:

Understanding Nutrition, 9th Edition, (2002) by Eleanor Noss Whitney and Sharon Rady Rolfes: Since it is a very readable and generously illustrated, it is a good book to browse, and since it contains so much information, it is a good reference book. It has 697 pages plus an appendix including an extensive Table of Food Composition and a good glossary. It includes some easily understood organic chemistry. (The amazon.com price for a new 10th hardcover Edition is $94.95. I bought a used hardcover 9th Ed. in like new condition for less than $13 including shipping. What a bargain! You can see why I like to buy a good used copy of the next to the last edition of a textbook. They are not too far out of date, and they are huge bargains.) This book gives a lot of information on foods, nutrients, and digestion processes, and it also has a chapter entitled "Planning a Healthy Diet." It explains three diet planning guides:

• Food Group Plans: In order to assure that one gets adequate vitamins and minerals one selects foods from five food groups (six including a fat group), which are cereal grain products; meats, poultry, and fish; milk products; vegetables; and fruits. The guidelines used by the authors for the desirable number of daily servings in each group come from the USDA. (As we have seen, the USDA standards are controversial.) You are advised to have 6 to 11 servings of grain, 3 to 5 servings of vegetables, 2 to 4 servings of fruit, 2 to 3 servings of meat, and 2 servings of milk daily.
• Food Exchange Lists: Since these lists are based on nutrient groups instead of food source groups, they assure that one gets adequate macronutrients, but without being combined with the food groups they don't assure that one gets adequate vitamins and minerals. The nutrient groups are the carbohydrates, fats, and proteins. The lists are of exchange units of approximately the same amount of the nutrient and calories. Therefore, any food on the list can be exchanged or traded for any other food in that category.
• Combination of Food Groups and Exchange Lists: The lists are categorized by food groups but list foods by exchanges thus assuring that one gets both an adequate intake of vitamins and minerals and of the macronutrients. One begins planning by deciding on how many calories are needed. Then one finds a guide as in Table 2-4 telling the number of exchanges from each food group to eat. If the calorie allotment is 1,735, then one should select 9 exchanges from the starch list to be divided into the three meals. The plan continues with 4 vegetable, 3 fruit, 6 lean meat (exchanges include beef, pork, poultry, and cheese), 2 nonfat milk (includes milk, yogurt, and buttermilk), and 5 fat exchanges (butter, margarine, oil, etc.).

We should be aware of the following with respect to the Food Groups and Exchange Lists: 1) They are based on the USDA's food guides in which 55-60% of the calories are from carbohydrates, 15-20% are from protein, and 30% are from fat, which are close to the mainline recommendations but are controversial. 2) The food choices do not take into consideration the G. I. of the carbohydrate foods. 3) The USDA recommended food group servings are quite controversial and the exchange system is more appropriate for dietitians than for lay persons who may prefer a simpler guide as in one of the above diet guides. For these reasons I would not use this nutrition textbook or similar textbooks to make my food plan. To learn more about the exchange system go to Dietary Exchanges and to Diabetes: Exchange Meal Plan.

Weight Control

Obesity in America may be our most serious health problem: 65% are overweight, 31% are obese, and 5% are severely obese (morbid obesity), according to the American Obesity Association, and the numbers are increasing. Obesity increases the risk of diabetes, hypertension, coronary artery disease, stroke, certain forms of cancer, gall bladder disease, respiratory problems, arthritis, hernia, and backaches. The connection between diabetes and obesity is so strong that medics have coined the word "diabesity," which is on an alarming upward trend in the US. (See Obesity, Type 2 diabetes, and physical activity) Obesity reduces physical activity that would burn calories, which results in more weight gain. For more go to Health Effects of Obesity.

About 30 % of schoolchildren are overweight, and this has serious consequences. A recent study found that teenagers who carry excess body fat but aren't necessarily overweight show evidence of reduced blood vessel elasticity, which leads to high blood pressure and is an early warning sign of cardiovascular disease in adults. Excess fat is more strongly linked to stiffer blood vessels than high cholesterol. For more information go to Extra Body Fat Harms Blood Vessels in Teens.

Obesity is a relative term, but if you want to know if you have made the team, go to Body Mass Calculator.

As mentioned above, a big tummy or "beer belly" indicates an accumulation of visceral fat, which is a serious risk factor if a man's tummy measures 40 or more inches and a women's is 35 or more. It is one of the factors associated with high blood pressure, high triglycerides, high LDL and low HDL cholesterol, and insulin resistance in the metabolic syndrome, which puts one at risk for a heart attack, stroke, or diabetes. For more information go to the excellent American Heart Association site, Metabolic Syndrome.

To maintain a healthy weight, all we have to do is to balance food energy intake with energy expenditure by metabolism and physical activity. So simple in theory and so difficult in practice! When we reduce our calories, our body prepares for hard times and reduces the basic metabolism rate. To make matters worse, according to "set point" theory, the body has a genetically set favorite weight that it stubbornly defends. These defenses were good in the Stone Age when it was important to have fat reserves to tide humans over when the food supply was low, but in this age of year-around abundance of food they work against dieting. Many people have a lifetime struggle against avoirdupois, and some go to the extreme of having heavy duty bariatric surgery such as stomach stapling. The good news is that exercise lowers the set point and raises the basic metabolism rate.

Fat is stored in fat cells, and the amount of fat stored depends upon the number and size of fat cells. The cells fill to a point and then divide. The more fat cells we have the more rapidly we regain fat that is lost. According to fat cell theory, it is important to prevent childhood obesity because new fat cells are mostly formed during childhood.

To lose 1 pound of weight, we must burn about 3,500 calories. To lose only one pound per week, we must have a negative balance of 500 calories a day. How can we do that without feeling starved? One strategy will not fit everyone, but here is a three-pronged attack that I would try after discussing it with my doctor:

1. Reduce caloric intake without reducing essential fatty acids, vitamins, and minerals and without cutting protein too much: To achieve the negative balance of 500 calories per day, we might cut intake by about 375 calories and increase physical activity to burn 125 calories. Look first to cutting saturated fats, trans fats, sugars, and high G. I. starchy foods. When we must be careful where we invest our calories, we need a food analysis table. We need not actually count the calories (I wouldn't.), but we need to be aware of the calorie load in our favorite foods and be aware of what is an appropriate serving size.

2. Increase physical activity and build muscle with resistance training to increase the basic metabolism rate: To see how much physical activity is required to burn our extra calories, go to Calories Burned Calculator. If we are physically up to it, we might add 30 minutes of brisk walking which would burn 125 calories per day.

3. Control hunger: Here are tips for reducing hunger:

   • Start the day with a good breakfast. The Tuft University nutritionists tell us that "eating more in the morning may help limit overeating at night." For more information go to Health & Nutrition Letter. Make sure that your breakfast provides you with adequate low G. I. carbohydrate, protein, good fat, fiber, and micro-nutrients.
   • Select low G. I. foods throughout the day. We have seen how eating a high G. I. food spikes our blood glucose level, which triggers the pancreas to give us a shot of insulin that makes the liver and muscles get busy converting glucose to glycogen and fat and storing it. The blood sugar drops, and we start feeling hunger again. What we need to do is to smooth out the peaks and valleys in the blood glucose level to minimize midmorning and afternoon hunger and to avoid unhealthful snacking.
   • Take into account the Fullness Factor when you are dieting. Some foods are better than others at giving us a feeling of fullness and reducing hunger. Foods high in water, protein, and fiber have the highest fullness ratings. See Fullness Factor. Eat your leafy green salad (with a low cal dressing) before your main course.
   • Have three smaller meals and two or three healthful snacks during the day. Good snack food includes almonds and other nuts, which are high in calories that must be offset elsewhere, soy nuts, turkey or beef jerky, carrot and celery sticks, a small apple, plain yogurt with fresh fruit, and cottage cheese with a tomato.

When we are grappling with our inner child over the prospect of a hamburger (2 to 4 Tbsp. fat) or French fries (1 or 2 Tbsp. fat) or chocolate cake (1 to 2 Tbsp. fat), we might picture in our mind taking a syringe and shooting the very questionable fats into our artery. Yuk! If that doesn't deter us, we should think about the calories. (burger - 400 to 700 calories; fries - 250 to 350; cake - 200 to 300) If we choose all three items, we will ingest about 3/8 of a cup of mostly bad fats and get from 850 to 1350 calories.

If I needed to lose weight, as noted above my choices among the above described diet books would be Living the G. I. Diet by Rick Gallop and The South Beach Diet: The Delicious, Doctor-Designed, Foolproof Plan for Fast and Healthy Weight Loss by Arthur Agatston, M.D.

To learn more about controlling weight go to Weight Control from Harvard. this contains a lot of advice that seems sensible to me.

"Calorie restriction" is a concept that is related to weight control and dieting, but it emphasizes the improvement of health and anti-aging rather than weight control. Calorie intake is minimized but the intake of needed nutrients is optimized. It is a proven strategy for extending life span in primates and other species, so the probability of doing the same for humans is an exciting prospect. Stay tuned on this important subject! For more information go to Hot Topic: Calorie Restriction.

Whole Foods

To have an optimum diet, we need to adopt a whole foods life style. For example, for breakfast we should have a whole orange instead of orange juice out of a carton or plastic container so that we have a fresh product and get the valuable fiber and nutrients in the pulp. Have whole grain cereals instead of cream of wheat, cream of rice, and grits and certainly instead of overly-refined, overly-sugared, cold kid cereals. Have "Old-fashioned" rolled oats instead of "quick oats" or "instant oats." Have whole wheat toast instead of white toast. Rather than using an egg substitute we can use fresh eggs, and if we want to cut down on the fat and cholesterol, we can separate out some of the egg yolks. For dinner we should have brown long grain rice instead of polished rice and especially instead of instant rice.

I use "grain" in a broad sense including the edible hard seeds of cereal grains such as wheat, oats, barley, and rye and seeds of other plants such as buckwheat, sesame seed, quinoa, flax, lentils, soybeans, and beans.

Supermarkets don't usually sell whole cereal grains other than brown rice, but many health food stores do. My favorite source is Bob's Red Mill in Oregon, and I order on-line. You can buy the intact grains or foods like steel cut oats or rolled oats, rye, and barley and stone ground flour. We can buy golden flax, sesame seed, and quinoa (an excellent substitute for cereal grains). I buy the intact cereal grains and grind or flake them myself just before I want to use them.

Some of the cereal grains such as wheat and rye thresh free from their hulls or scales, and the seeds are often called "berries." Other cereals such as most oats and barley, especially those grown for farm animal feed, do not; however, there are "naked" species of oats and barley. Oats and barley without hulls are called "groats" and are suitable for human consumption. "Pearled" barley has the hull, germ, and some of the bran removed; therefore, it cooks more rapidly.

A naked cereal seed or berry consists of the germ and an outer layer of bran covering a starchy endosperm. The germ is very nutritious, but when it is milled, its oil becomes rancid if not stored under refrigeration. Therefore, we should keep milled whole cereal grains in the refrigerator except for rolled grains in which the enzymes causing rancidity are deactivated by heat. The bran is a good source of fiber and contains other nutrients. The endosperm is mostly starch, but it also contains significant protein. The protein in bread wheat is high in gluten, which makes an elastic dough that can rise during fermentation. However, some people do not tolerate gluten well.

Although I am high on whole, fresh, and local foods, I am only moderately enthusiastic about "organic" foods, but I would be more interested if I were rearing children. The Harvard School of Public Health on their Web site says, "Organic fruits and vegetables will limit your exposure to pesticides. However, organic produce tends to be much pricier than conventional produce, and may not be any more nutritious than conventional fruits and vegetables." If you are interested in whole wheat bread making I invite you to go to my bread page, Bread Machine Baking.

My Nutrition Rant

We hear a lot of talk (talk not action) about reducing health care costs and increasing health care coverage in the United States. What we eat is a large determinant of our health and health care costs. If we want to get serious about our health, we must improve our lifestyles and, especially, our nutrition! Here are few things that occur to me that we can do:

• We need to launch an effective massive health education program for adults and children through the media and in schools, so that everyone knows which foods are healthful and which are not and why and how to read and interpret "nutrition facts" on labels.
• We need to overhaul school lunch programs so that they demonstrate good rather than bad nutrition.
• Food advertising aimed at children must not be tolerated.
• If it is desirable for the FDA to prohibit unsafe drugs, it should be acceptable for them to prohibit unsafe foods such as trans fats.
• We need more disclosure. When we buy a hamburger and fries, we should be informed about what we are eating and what risks it poses. If warning labels make sense on cigarettes, they make sense on hamburgers and french fries. McDonald's is beginning to put nutrition labels on some items.
• Medical schools should train primary care doctors more thoroughly in nutrition and place as much emphasis on proper eating and disease prevention as on drugs and surgery. The number of heart by-pass operations performed is not a tribute to our health care; it is a black mark on disease prevention efforts. Medical licensing should require periodic additional education in nutrition and disease prevention. Medical societies should promote more attention to disease prevention.
• We need to transfer the responsibility for nutritional guidance from the USDA, which is more concerned with the welfare of farmers than of consumers, to HHS. We need to isolate people doing health research and making health decisions from politics.
• We need a single-payer health insurance plan covering everyone that emphasizes disease prevention as well as disease cure. Any mention of single-payer health insurance always causes free market ideologues to scream "socialized medicine." We already have a successful single-payer system for seniors called Medicare; now we need to make universal. Go to Health Care Systems: An International Comparison. Compare what we spend and what we get for it. Perhaps as more large corporations struggle with health insurance costs and as more companies eliminate health insurance coverage, single-payer health insurance will look better and better. I dislike the expression, but this is a "no brainer."
• We must reform political campaign financing and lobbying rules in order to make much progress in health care. We have to be able to hold special interests at bay.
• We consumers and dietitians must take the best nutrition advice seriously. For example, a friend of mine lives in a retirement community. A recent typical lunch consisted of a fruit salad (good), cream of celery soup (cream soups are not good), quiche (too much saturated fat), and chocolate cake (very bad). Typically, a good proportion of retirement community residents are overweight and hypertensive. They should receive a healthful diet and be encouraged to exercise. If there isn't a refund of entry fee upon death, there isn't much incentive for management to prolong the life of residents.

Back to the Beginning

Your feedback will be welcome. Please send an e-mail message to me, Bob Parvin: bandcparvinXhotmail.com (Substitute @ for X. I'm trying to hide my address from spammers.)

Copyright © 2005 Robert G. Parvin. This web site is made available free of charge "as is," with no warranties whatsoever. Some of the food suggestions in this page may not be suitable for everyone, so if you are uncertain confirm their suitability by consulting your health professional. If you are dissatisfied with this web site, or any portion thereof, your exclusive remedy shall be to cease using the web site.